The applicant is requesting five years of funding through the Mentored Career Development Award (K23) program to complement her training in pediatric emergency medicine and health services research with skills needed to conduct research on screening for mental illness emergency department settings (ED). These skills will include advanced training in psychiatric assessment and psychometrics with particular attention on how these skill sets are applied in an ED setting. In addition, the applicant will enhance her knowledge of decision analysis with the intent to apply this methodology for the decision of whether or not to screen for mental illness in the ED, and if so, which populations to target. The long-term goal is to become an expert in screening services in the ED setting, understanding the multitude of issues that effect the screening effectiveness in this setting. Ultimately, the goal is to field a multi-ED study of mental health screening followed by a collaborative ED-based mental health intervention, for children with mental illness who present to the ED. The research plan is divided into two separate projects that balance the aims set forth in the proposed career development. The first study in years one through three, will involve the mental health screening of 600 children and their mothers who present to the ED for medical complaints. From this set of interviews, a prevalence estimate of mental illness in the ED setting will be calculated along with the identification of risk factors for the presence of mental illness in children. The second study, to be formulated during years 3-5 will construct a decision analysis examining the decision of whether or not to screen for mental illness in the ED setting. Utilizing information about risk factors from study one, and information from the literature, this study will examine screening strategies for children who present to the ED with mental illness.